Parental BMI and weight gain in infancy predict increased circumference at age 5

Changing definitions of obesity, changing patterns of food production and consumption, and changes in food preferences in westernized countries have contributed to the current global childhood obesity pandemic. Since overweight and obesity increase the risk of many metabolic diseases, including type 2 diabetes, hypertension and cardiovascular disease (CVD), there has been increased interest in the early detection of markers of metabolic syndrome in children as young as preschoolers.

A new PLOS A A study reports a correlation between parental weight and rapid weight gain in children with increased abdominal fat at age five.

Study: Early rapid weight gain, parental body mass index and association with increased height-to-height ratio at age 5 years.  Image <a class=Credit: andrey2017 /” class=”rounded-img” data-src=”” data-srcset=” 1000w, 950w, 750w, 550w, 450w” sizes=”(min-width: 1200px) 673px, (min-width: 1090px) 667px, (min-width: 992px) calc(66.6vw – 60px), (min-width: 480px) calc(100vw – 40px), calc(100vw – 30px)” style=”width: 1000px; height: 667px;” width=”1000″ height=”667″/>

Study: Early rapid weight gain, parental body mass index, and association with increased height-to-height ratio at age 5 years. Image Credit: andrey2017 /


The need to identify predictors of excessive childhood weight gain has led to an increase in research on markers of abdominal obesity in the pediatric population. It has been suggested that waist-to-height ratio (WHtR) and waist circumference (WC) are suitable for this purpose, as they are reliable in their correlation with cardiometabolic risk and simple to perform.

Previous research has shown that children who gain weight rapidly in the first two years of life are more likely to become obese and have abdominal obesity as adults.

Several reasons have been suggested for this association, including increased protein and sugar content of infant formula compared to breast milk, volume of milk ingested per feeding, time of feeding, risk overfeeding and emptying of the bottle by the infant, all of which precede rapid weight gain (RWG) in infants. It could also affect the composition of the gut microbiome.

Low birth weight and maternal weight gain during pregnancy are other risk factors for abdominal obesity in children aged two to nine years. A high body mass index (BMI) before pregnancy is another risk factor, as are increased time spent watching television and lower socioeconomic status.

The current study is among the few that examines children under the age of six in an attempt to identify risk factors for abdominal obesity.

Study results

The study included a cohort of Swedish preschoolers as part of the Halland Health and Growth Study (H2GS), which included more than 2,600 children born between October 1, 2007 and December 31, 2008 in Halland, Sweden. The current study included 1,540 children.

When classified by birth weight, 3% were small for gestational age (SGA) at birth, 93% were normal weight, and 4% were large for gestational age (LGA). According to BMI, 87% were normal weight, 2% underweight, 9% overweight and 2% were obese.

According to the WHtR, which is calculated as waist circumference (cm)/height (cm) transformed into sex- and age-specific standard deviation scores (SDS), 15% of five-year-olds had a value greater than or equal to one, compared to 85% with a value less than one. Children with increased waist circumference at age five were more likely to gain weight rapidly in the first six months of life, as well as to have heavier mothers and fathers before conception.

In fact, RWG in the first six months of life doubled the risk of WHtR being greater than one in five years. While RWG at six to 12 months, dairy grain consumption at two years, and bottle-feeding in the first two years of life were also risk factors for a higher WHtR at five years, this effect was not reported after accounting for other confounders.

Children with RWG in the first year of life were twice as likely to have abdominal obesity by age five. Higher maternal BMI before pregnancy also had a small effect, increasing the risk by about 10% of higher WHtR and abdominal obesity in five-year-olds. Paternal BMI also increased risk, but only for WHtR.


Early RWG, higher pre-pregnancy BMI, as well as higher paternal BMI are associated with higher waist circumference for height. RWG throughout the first year of life, associated with higher pre-pregnancy BMI, increased the risk of being overweight or obese by age five.

Similar results have been reported in children as young as two years old and, together with the current study, support the hypothesis that RWG predicts later health risks through its role in abdominal obesity.

Preventive interventions for abdominal obesity and childhood overweight should target early rapid weight gain, parental overweight and parental obesity.”

Infants mainly carry subcutaneous fat; however, during the second year of life, fat mass increases mainly in the visceral area of ​​the abdomen. It is also the site of fat storage in children who show RWG during the first two years of life. It is also believed that older children gain belly fat when they become obese.

Our results indicate that the first six months of life is a crucial period that requires further investigation regarding these associations..”

Further studies will be needed to validate and elucidate how maternal BMI before pregnancy is associated with an increased risk of increased waist circumference and overweight or obesity in young children. In addition, researchers will need to determine whether the risk factors identified in this study are also linked to excessive weight gain and abdominal obesity in children six years of age and older.

The current study also indicates that the aforementioned factors are more important than bottle feeding or dairy cereal consumption in infants, although these have been linked to obesity in other studies. This association may be indirect; thus, follow-up studies are needed to confirm the role of early feeding practices in weight gain later in life.

Journal reference:

  • Lindholm, A., Almquist-Tangen, G., Alm, B., et al. (2022). Early rapid weight gain, parental body mass index, and association with increased height-to-height ratio at age 5 years. PLOS One. doi:10.1371/journal.pone.0273442.

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